All About Estates

Dr. Richard Shulman

Total 53 Posts Website
Dr. Shulman is a geriatric psychiatrist at Trillium Health Partners and is an assistant professor at the University of Toronto. He is medical director of the Capacity Clinic and available for independent medical-legal capacity assessments.

Capacity Evaluation – the Role of Corroborative Information at CCB Hearings

In my last blog, I described the Court’s expectation for confirming a finding of incapacity: namely, that compelling evidence is required to override the presumption of capacity. Such evidence may include corroborative information. However, the Court has warned assessors to be alive to the presence of improper motives of informants…

Continue Reading

Capacity Evaluation: the Role of Corroborative Information

In clinical geriatric psychiatry, it is an accepted standard of care to obtain corroborative information when conducting clinical evaluations.However, medical-legal tasks of capacity evaluation, such as for the evaluation of capacity to instruct counsel, testamentary capacity and possibly even capacity to appoint powers of attorney, may require strict confidentiality which prevents obtaining corroborative information from informants. As a result, obtaining corroborative information for capacity evaluation in this context is more complex than in clinical care.

Continue Reading

Suggested Instructions for Attorneys for Personal Care: Limitations of Authority

It is just as important to know the limitations of a power of attorney for personal care as it is to know your responsibilities.

Continue Reading

The Bio-Psycho-Social Approach to Capacity Evaluation

Current approaches that define capacity in cognitive terms disregard concerns that emotional instability may disrupt capacity or that a person may be cognitively intact yet lack the capacity to give a valid consent. An alternative evaluative approach would be to view capacity holistically, as a combination of biological, psychological, and social (biopsychosocial) factors.

Continue Reading

More Commentary on the Evaluation of Capacity to Consent for MAiD

There appears to be a lack of consensus in the mental health field whether persons with a mental disorder-sole underlying medical condition can be adequately evaluated for capacity to consent to MAiD.

Continue Reading

Update on Suggested Amendment for Capacity to Consent to MAiD

I suggest “an appreciation of the impact MAiD will have on family members and friends” be included in fulfilling the proposed amendment of the appreciation test for consenting to MAiD. The proposed amendment would not mandate being bound by others’ opinions, but that that lack of ability to appreciate the views of one’s significant others would demonstrate a lack of ability to apply the relevant information to one’s circumstances.

Continue Reading

Update on MAiD: Mental Disorder as a Sole Underlying Medical Condition

In Canada, the law no longer restricts medical assistance in dying (MAiD) to people whose death is reasonably foreseeable: as of March 17, 2023, people with a mental disorder as a sole underlying medical condition (MD-SUMC) will be eligible for MAiD.

Continue Reading

Capacity to Consent to MAiD: A Suggestion For Amendment

I have found it uncommon for a family member or beneficiary to exert undue influence to pressure a patient to pursue MAiD. What worries me is the vulnerability of patients to undue influence from physicians who may embrace therapeutic nihilism and bias patients unduly towards MAiD. I suggest that, for capacity to consent to MAiD, the test of “ability to appreciate” should be expanded to require an appreciation of the views and wishes of supportive family members and friends.

Continue Reading

Role of the Health Practitioner at Board Hearings: Recommendation for Reform

The Consent and Capacity Board (“Board”) in Ontario is a quasi-judicial administrative tribunal which operates at arm’s length from the Ministry of Health. The Board convenes hearings and makes decisions under six pieces of legislation, but most hearings relate to the Health Care Consent Act (HCCA) and the Mental Health…

Continue Reading

Dementia, Health Law and Discharge Planning Challenges

A clinical dilemma: a patient was diagnosed with dementia in the mild-to-moderate stage requested to be discharged home from hospital to live alone despite the opinion of the attorney for personal care and property that the patient is unsafe to do so. The clinical opinion was also that the patient…

Continue Reading